Midterm Budget Adjustments for the Department of Social Services - CT.gov

Page created by Billy Reeves
 
CONTINUE READING
Midterm Budget Adjustments for the Department of Social Services - CT.gov
Governor’s SFY 2017
          Technical BudgetSFY
               Governor’s  Adjustments
                              2021
      for the Department  of Social Service
      Midterm Budget Adjustments for the   s
          Department of Social Services

Presentation to the Legislative Appropriations Committee
               Deidre S. Gifford, Commissioner
            Michael Gilbert, Deputy Commissioner
               Wednesday, February 19, 2020
2/19/2020              Department of Social Services   1
Midterm Budget Adjustments for the Department of Social Services - CT.gov
DSS at a Glance
                              • Serves children, adults, working families, older adults and
                                persons with disabilities in all 169 Connecticut cities and
Critical source of economic     towns.
 security, health and well-   • With service partners, provides federal/state food and
being to about one million      economic aid, health care coverage, independent living and
  individuals (28% of the       home care, social work, child support, home-heating aid,
                                protective services for the elderly, and other vital services.
population of Connecticut)
                              • Successful in improving quality, satisfaction and
                                independence through prevention and integration.

                              • Prioritizing timely access to services through eligibility
                                process improvements, integration with Access Health CT,
                                and our ImpaCT eligibility system.
   Technology and data        • Beginning efforts to modernize our child support and
         driven                 Medicaid technology supports and systems.
                              • Utilizing advanced data analytics to direct policy-making,
                                program development and operations.

                              • Agency-wide administrative costs are estimated to be 3.3%.
                              • Total staffing of approximately 1,710
                              • Over 50% of agency expenditures are federally reimbursed.
  Efficient and effective     • Health expenditures (76% of department’s recommended
         operations             SFY 2021 budget) are increasing based on caseload growth,
                                but trends in per person costs are stable (SFY 2019 at the
                                same level as SFY 2014), and quality outcomes have
                                improved.
                                                                                                 2
Midterm Budget Adjustments for the Department of Social Services - CT.gov
DSS at a Glance

                  Our Mission

Make a positive impact on the health and well-being of
 Connecticut’s individuals, families, and communities

                                                         3
DSS at a Glance

            Notes:
            • Medical includes individuals receiving HUSKY, MSP, and state-funded Home Care
            • Other includes Essential Services and SAGA funeral benefits
            • Reflects average monthly enrollment

2/19/2020                                Department of Social Services                        4
DSS Budget at a Glance

 The Department is committed to providing the highest level of health and
  human services to Connecticut individuals, families and communities. Our
  services touch people in all 169 cities and towns.

 We support Governor Lamont’s recommended SFY 2021 budget adjustments for
  the Department. We believe they will allow us to support our mission and
  provide us with the resources necessary to continue efforts to assist those who
  benefit from our services.

 We look forward to working with the General Assembly over the next several
  months as you review and deliberate on these budget adjustments.

 In the next few slides, we present a general overview of the DSS budget before
  detailing the changes included in the Governor’s budget adjustments.

                                                                              5
DSS Budget at a Glance

 The Department continues to focus on providing the best possible
  services to our clients in the most effective and efficient manner.
  This is evident through several key benchmarks including, but not
  limited to, the following:
    Application timeliness at levels of 98% for Supplemental Nutrition
     Assistance Program (SNAP) and Medicaid
    Average benefits center wait times are down over 80% from last year
    Administrative cost ratios are at extremely low levels
    Medicaid per member cost stability - per member per month (PMPM) costs
     in SFY 2019 are at the same levels as in SFY 2014
    Medicaid state share cost stability - the state share of Medicaid costs, those
     borne by the state General Fund, increasing by an annual average of only
     1% since SFY 2013.

                                                                               6
DSS Budget at a Glance
   Programs supported include:                                        SFY 2021 Governor’s recommended
     Medicaid, CHIP (HUSKY B), SNAP, TFA, Child                         budget:
     Support, State Supplement (AABD), SAGA, Energy               •     Total:
     Assistance, Community Action Agencies                               • SFY 21 $4.700 b (net); $8.735 b (gross)
                                                                  •     Program:
   SFY 2020 estimated staffing costs:
                                                                         • SFY 21 $4.419 b (net); $8.454 b (gross)
      •     $ 128 m
                                                                  •     Administrative:
   Major operating expenses (non-staff):
                                                                         • SFY 21 $281.1 m
      •     Estimated 2020 expense: $153 m
      •     Operating Contracts: 88%
      •     Facilities & Operational: 12%                              Federal reimbursement in SFY 2020:
                                                                             •   59% - Medicaid program costs
   Administrative cost ratio:
                                                                             •   75% - Medicaid systems and eligibility
      •     3.3% (includes eligibility staff; based upon
                                                                                 (staff & contracts), & new IT system
            total budget inclusive of federal & state funds)
                                                                                 operational costs
                                                                             •   50% - Medicaid administrative costs
   Program outcome highlights:                                              •   50% - SNAP administrative support
      •     Application processing timeliness                                •   66% - Child Support
      •     Significant reductions to the average benefits                   •   80 to 90% - IT systems development
            center wait times
                                                                             •   76.5% - CHIP (HUSKY B) (beginning
      •     Continued stability in the Medicaid cost                             10/1/19)
            trends and enhanced outcomes while
            maintaining a low administrative cost ratio                      •   100% - TANF programs and administration
2/19/2020                                    Department of Social Services                                          7
DSS Budget Overview
 Total funding for SFY 2021 is $4.700 billion, which is an increase by $168.6
  million over estimated SFY 2020 levels.
 The overall change in the DSS General Fund budget for SFY 2021 is an
  increase of 3.7% above SFY 2020 budgeted amounts.

  2/19/2020                      Department of Social Services                   8
DSS Budget Overview

                                            This graphic
                                            depicts the relative
                                            share of the
                                            Department’s
                                            General Fund
                                            budget allocations
                                            by major core
                                            program
                                            groupings; this
                                            does not include
                                            the federal share
                                            of Medicaid
                                            funding or any
                                            other federal funds
                                            managed by DSS

2/19/2020   Department of Social Services                   9
DSS Budget Overview

Summarizing the graphical information presented on the prior page:

 The proportion of the DSS General Fund budget directed to Medicaid is 61%
  in SFY 2021 . Other health services account for an additional 15% of the
  budget in SFY 2021.

 Administrative, field operation and grant expenses account for 6% of our
  General Fund budget in SFY 2021.

 The budget share for income support, including Temporary Family Assistance,
  State Supplement (Aid to the Aged, Blind and Disabled), and State
  Administered General Assistance, is 4% in SFY 2021.

 Community Residential Services, funding programs provided by the
  Department of Developmental Services, accounts for the balance of 14% in
  SFY 2021.
  2/19/2020                    Department of Social Services                  10
DSS Budget Overview - Medicaid

Hospital services
account for the
largest share of the
DSS Medicaid spend
at 30%, followed by
nursing homes and
LTC facilities at 21%.
Waiver/CFC services
account for 13%.
Physician expenses
comprise close to
11%.

Note: Represents both state
and federal shares of
Medicaid funding. Excludes
hospital supplemental
payments of $493.3 million    Home Care/Waiver Services also includes Home Health and Community First Choice (CFC)
which were paid outside of
the Medicaid account.
   2/19/2020                          Department of Social Services                                            11
SFY 2021 Baseline Changes
In aggregate, the recommended total DSS adjustments from our original
SFY 2021 biennial appropriation is an increase of $33.1 million, or 0.7%

The Governor’s Midterm Budget Adjustments include the following
baseline changes:
 Caseload and cost updates to reflect trends
   • A net increase of $47,080,000 is recommended to meet program
     requirements for DSS medical and cash assistance accounts to reflect
     caseload and cost trends including the following:
             •   $53.0 m Medicaid
             •   $0.7 m HUSKY B
             •   -$6.4 m Aid to the Aged, Blind and Disabled (State Supplement)
             •   -$3.1 m Temporary Family Assistance
             •   -$0.6 m State Funded CT Home Care Program
             •   $1.1 m State Administered General Assistance
             •   $2.4 m Community Residential Services (DDS)

 2/19/2020                              Department of Social Services             12
SFY 2021 Baseline Changes
The Governor’s Midterm Budget Adjustments include the following
baseline increases (continued):
 Reflect the Impact of the Minimum Wage on Private Providers:
   • Additional funding in the amount of $146,765 is recommended for
      grantee-based and residential care homes minimum wage
      requirements which are transferred from OPM to agency budgets.

 Centralize Funding for the Microsoft 365 Statewide Agreement:
   • A reduction in funding in the amount of $513,693 is recommended
     in the DSS Other Expenses account to support the centralized
     purchase and management of Microsoft 365 software licenses.

 Transfer Reserve for Salary Adjustment Funds for Bargaining
  Adjustments Approved in 2019 Session (addition of $45,207 to DSS)

 2/19/2020                 Department of Social Services              13
SFY 2021 Baseline Changes

The Governor’s Midterm Budget Adjustments include the
following baseline increases (continued):
 Align Hospital Supplemental Payment Appropriation with Hospital
  Settlement Agreement
   • A technical adjustment reduction of $31,102 is recommended to align
      appropriated funding to amounts agreed to in the hospital settlement.

 2/19/2020                    Department of Social Services                   14
SFY 2021 Budget Savings
The Governor’s Midterm Budget Adjustments include the
following savings:
 Claim for Certain Residential Care Home Services under Medicaid:
   • A savings of $2,110,000 is recommended to reflect access to federal Medicaid
      reimbursement for certain Residential Care Home (RCH) services that are
      already paid by DSS under the state-funded State Supplement for the Aged,
      Blind and Disabled. A reinvestment estimated at 25% of the additional federal
      reimbursement is targeted for the RCH providers.

 Implement Third Party Liability Prompt Pay Requirements to Strengthen Claims
  Billing
   • A savings of $2,000,000 is recommended based upon requiring insurers to act
       in a timely manner on requests to reimburse for services covered under
       HUSKY Health for which they are legally liable. This is consistent with industry
       practice and will reduce Medicaid funding requirements.

 Maintain Existing SFY 2020 Rates for Natchaug Hospital:
   • A savings of $454,000 is recommended associated with funding that was
     originally included in the SFY 2021 budget for a rate increase for Natchaug
     Hospital, thereby maintaining their rates at SFY 2020 levels.
 2/19/2020                       Department of Social Services                      15
SFY 2021 Budget Changes
 The Governor’s Midterm Budget Adjustments include
  the following adjustments to DDS services funded
  under the DSS budget:
 Increase Use of Rent Subsidies to Support Transitions to More Appropriate Levels
  of Care (DDS)
   • Funding in the amount of $778,560 is transferred from the Community
      Residential Services account to the DDS Rental Subsidy account to support
      approximately 160 individuals transitioning into less intensive residential
      placements. The use of these settings, including continuous residential
      supports and individualized home supports, will result in a savings of
      $1,021,440.

 Incentive Payments for Providers Transitioning Individuals to Less Intensive
  Settings (DDS):
   • A savings of $1,750,000 is recommended to reflect a new reimbursement
      method targeted to incentivize providers to allow individuals to be served in
      less intensive settings; this will allow for providers to be reimbursed at a
      portion of their payment for two years for individuals transitioning to lower
      levels of care, resulting in a net state savings overall.

 2/19/2020                       Department of Social Services                   16
SFY 2021 Budget Changes

 The Governor’s Midterm Budget Adjustments
  include the following reductions to DSS
  administrative accounts:
 Achieve Administrative Savings from SFY 2020 Holdbacks
   • A reduction in funding in the amount of $1,100,000 under Personal Services
      and $1,156,533 under Other Expenses is recommended to continue SFY 2020
      holdbacks savings achieved in those accounts.

 Achieve Additional Efficiencies under the Other Expenses Account
   • A reduction in funding in the amount of $1,457,600 is recommended to reflect
      efficiencies in phone service costs, office equipment costs, operational
      support contracts, support needs for certain technology functions, and the
      availability of federal funds for certain efforts not originally anticipated.

 2/19/2020                      Department of Social Services                  17
SFY 2021 Budget Reallocations

The Governor’s Midterm Budget Adjustments include the
following reallocations of funding:
 Centralization of Human Resources and Labor Relations Staff
   • Sixteen positions and $1,383,808 in Department funding for Human Resources
     and Labor Relations functions are transferred to the Department of
     Administrative Services and the Office of Policy and Management as part of
     the statewide consolidation of such supports.

 Transfer Funding for the Center for Medicare Advocacy
   • Funding of $300,000 for services originally budgeted under the Department
      for the Center for Medicare Advocacy is transferred to the Department of
      Aging and Disability Services to reflect the more appropriate alignment of
      these services.

 Transfer Funding for Mary Morrisson School Based Health Center
   • Funding of $125,000 for services originally budgeted under the Department
      for the Mary Morrisson School Based Health Center is transferred to the
      Department of Public Health to reflect the more appropriate alignment of
      these services.
 2/19/2020                     Department of Social Services                   18
Notable Agency Achievements

    In the next several slides, we will review some of the
    major accomplishments achieved with funding
    provided to DSS in support of services to our clients

2/19/2020                Department of Social Services       19
Achievements – Benefits Centers by the Numbers

 3: The number of Benefits Centers
 7:30am-4:00pm: Hours of Operation Monday-Friday
 24/7: Hours and Days that clients can access the interactive voice
  response system (IVR)
 3,329,907: Total calls answered since July 2013
 43,919: Average monthly volume of calls answered (10/19 – 1/20)
   • Calls answered by workers are across all DSS programs including
      Medical, SNAP, and Cash Assistance.
 114,502: Average monthly volume of calls to the IVR (10/19 – 1/20)
 13,978: Average monthly volume of telephone interviews
 80%: The decrease in the average monthly wait time from 75
  minutes to 15 minutes in 2019
 15: The average monthly wait time minutes in 2020

2/19/2020                 Department of Social Services           20
Achievements – Benefit Centers
                                    Benefits Center Average Wait Time (in minutes) Jan 18 - Jan 20
          120
                      106 107 105
                100
          100                        96

                                          85
                                               77
          80
                                                    66
Minutes

          60
                                                         50
                                                              45

          40                                                              35
                                                                     32
                                                                               28
                                                                                                             25
                                                                                                                  21
                                                                                                        16             17             18
          20                                                                                                                     13        15
                                                                                    9              10                       11
                                                                                         8    7

           0

           The Benefits Centers are located in three of the twelve DSS field offices. Each contains an interactive voice response
           system with 24/7 access to DSS and offers callers the option of obtaining a secured PIN to self-serve. The Benefits Centers
           are open Monday-Friday, 7:30am-4:00pm. Callers use one statewide phone number, 1-855-CONNECT (1-855-626-6632).
           The Benefits Centers offer live processing by eligibility workers who possess specialized program and policy
           knowledge. Workers screen for callers with disabilities requiring special accommodations. Over the past two years, the
           Benefits Centers have experienced a significant downward trend in wait times. The marked decrease in wait times is a
           result of continuous improvements to business processes made by the Department.
            2/19/2020                                              Department of Social Services                                                21
Achievements – SNAP Timeliness

2/19/2020     Department of Social Services   22
Achievements – Medicaid Eligibility Timeliness

2/19/2020      Department of Social Services             23
Achievements – Health Services

DSS’ strategic framework demonstrates results – Health Services

      • The following slides demonstrate our successes in the
        following critical areas:

            • Expanding provider networks and opportunities for client access

            • Increasing routine care for clients

            • Reducing utilization of hospital inpatient services

            • Reducing the use of hospital emergency departments

            • Stability of costs – expenditures, per member per month (PMPM)
              costs, share of overall state budget

2/19/2020                         Department of Social Services                 24
Achievements - Addressing Access

               Our Provider Network Continues to Grow
            Connecticut Medical Assistance Program (CMAP)
                          CY 2015 – CY 2019

2/19/2020                   Department of Social Services   25
Achievements - Utilization Improvements

                Routine care is increasing
            Utilization Changes: Physician Services

2/19/2020              Department of Social Services   26
Achievements - Utilization Improvements (cont.)

            Hospital utilization is decreasing
                      Inpatient Metrics

2/19/2020             Department of Social Services         27
Achievements - Utilization Improvements (cont.)

 Emergency Department utilization is decreasing

2/19/2020           Department of Social Services         28
Comparison with National Trends

       * Expenditures are net of drug rebates and exclude hospital supplemental payments given the
       significant variance in that area over the years
2/19/2020                                Department of Social Services                               29
Federal and State Share of Medicaid

CT’s state share of
Medicaid costs have
stabilized.

State share of costs was
virtually unchanged from
SFY 2013 to 2017.

SFY 2019 state share was
only $151 million, or
6.1%, higher than the
estimated SFY 2013 state
share. This equates to an
average annual increase
of 1.0%.

SFY 2018 and 2019 begin
to rise due to lower
reimbursement for the
expansion population
(HUSKY D) and hospital                                       *Excludes hospital supplemental payments

rate increases.
   2/19/2020                 Department of Social Services                                              30
Medicaid Share of Total CT Budget

 Total Medicaid expenditures as a percentage of the total state
  budget - detail on peer states and national data*

                                                                                 CT’s Medicaid to
                                                                                 total state budget
                                                                                 cost ratio was
                                                                                 lower than the all
                                                                                 states average
                                                                                 and the average
                                                                                 of its peer states
                                                                                 from SFY 2015
                                                                                 through 2019

 *Per National Association of State Budget Officers (NASBO) State Expenditure Reports; includes both
 federal and state Medicaid shares
2/19/2020                              Department of Social Services                                   31
Additional Fiscal Presentation

 For additional information on financial trends under the
  HUSKY Health program, the Department recently presented to
  the Medical Assistance Program Oversight Council on
  February 14, 2020

 That presentation will be made available shortly at our DSS
  website

2/19/2020               Department of Social Services           32
Closing
 In closing, the Department recognizes our significant
  stewardship role as we manage $4.7 billion in State General
  Fund resources, as well as an additional $4 billion in federal
  funds.
 As can be seen by some of the achievements we focused on,
  our Department is fully committed to providing the highest
  level of support for our customers within the budgeted funds
  received.
 We appreciate the funding included in the Governor’s
  recommended midterm budget adjustments, which will allow
  us to continue these efforts.
 At this time, we are available to respond to any questions you
  may have.
2/19/2020                 Department of Social Services            33
You can also read